Until the Internet age, information sources on hearing aids were limited to the opinions of those working at hearing aid clinics and those who wear them. Internet postings, however, are written by people who also, as all of us do, have biases and are affected by them.

It's fair to say that all hearing aid manufacturer's postings will understandably praise only themselves, in the same manner that automobile manufacturer 'A' would also only self praise and not declare that 'B' might actually has more reliable models? If the information comes from a hearing clinic they may have their own biases, be they unsubstantiated, from personal experience or from the directives of superiors. Lastly, the opinions expressed by those who wear them are indeed valid, but limited solely to their own experiences, hearing aids, types of loss and the clinic which dispensed them and no more. Thus finding the right information and guidance can be a daunting process, but by the very fact that you’re reading this blog suggests that you've started to educate yourself, whether for personal reasons or for someone else.

So what do you -the patient- do in this situation? Education is step one and step two comes from the 'gut-feelings' you get from the advise.

Manufacturers/Clinic relationships Before any hearing aid can be fitted, a manufacturer must develop then market their products to the dispensing clinics.

All manufacturers offer seminars to us, the clinicians, which are chalked full of information, testimonials and statistics from assorted trials and studies; they want us to learn about and hopefully love their products, and if we truly do, we then recommend them to our patients.

With a dozen main manufacturers in Canada, there is indeed a lot of choice and 'compelling evidence' that we must sort through. Our decisions are generally made with the following 'check-list' gleaned from personal experience and peer reviews:

Are the hearing aids build upon previous lines that garnered accolades?

Does that manufacturer have a reputation for reliable products, good warranties and technologies which offer that 'something special'?

Finally, are there incentives for the clinic, such as good customer support and training which would help it operate more efficiently?

With all this said and done, it's now a matter of business and professional ethics as to what is actually done with that knowledge.

Independent verses chain-style/manufacturer owned clinics

Clinics can be broken down into basically two groups: independents and large chain-style organizations, of which many today are owned by manufacturers. There are important differences which you should be aware of.

Independent clinicsare local small businesses usually employing only a few people, which often includes the owner. As the name suggests, they are not owned by any corporate master or manufacturer and offer a wide variety of hearing aids, without prejudice. They can also be much more flexible and sensitive to the needs of each individual patient, as decisions can be made on-the-spot, without rigid corporate policy to follow.

Chain-style/manufacturer owned clinics are generally organized as multi-level corporate structures, often with policy dictated by off-site ownership, which in some cases is based in the U.S. and Europe.

Perhaps the most disconcerting development associated with many of these is the subject of ownership, or more precisely the risks of ownership: Hearing aid manufacturer's have been purchasing local, provincial and nation-wide clinic chains with increasing frequency throughout Canada over the last few years. The risk to consumers is that the clinic's staff may come under pressure to recommend a disproportionately high portion of hearing aids from its parent company, possibly when it's even against their personal preferences. Some chains also “rebrand” their products, acting to hide their true identity, which allows them to declare that "they are the only ones" that can provide a particular 'brand'. This leaves the consumer unable to effectively compare 'apples-with-apples'.

Legislated policy in Ontario's hearing aid industryAs of 1987, hearing clinic's in Ontario must be registered with and adhere to the policy's of the Province's Assistive Devices Program (ADP), in order to dispense hearing aids. At ADP's inception, one of the practices they addressed and subsequently eradicated was with the 'Beltone Better Hearing Centres' clinic model, which would only recommend their own products. ADP knew full well that this could result in second-rate hearing health care.

ADP's policy also states that clinic's must have accounts with multiple manufacturers and as such be able to dispense more than one brand, but in practice do they actually do so? I don't have all the answers, but I do know that throughout Ontario (and Ottawa) most chain-clinics are manufacturer owned and some of them do re-brand.

Some final thoughts

Each time a hearing aid is dispensed to a patient, a clinic's reputation is put on the line, which for a independent is a very important line. Simply put, we have to be good at what we do, since we lack any safety-nets from large corporate owners which can pour vast sums of money into TV, radio and full-page newspaper ads that will, if it occurs, offset the affects of negative reviews voiced by dissatisfied patients.

We base a lot of our survival upon the referrals of physician's and by word-of-mouth and, if for no other reason than that, must always do what is in our patients best interests and not just the 'bottom-line. Period.

Lastly, the role of an independent owner is usually quite different from the roll of the owner(s) of many chain-style clinic's: what we see before us are the patients we test, fit hearing aids on and get to known personally and not, perhaps, assorted growth charts and accounting reports, likely read many time-zone's away. The independent owner also has a huge personal stake in the company's reputation and survival.

As for my first question about what to do when choosing a clinic, hopefully this helps a bit with the education part, but as for the 'gut-feeling' part that is your own to explore.

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